肺癌脑膜、脊膜转移15例临床分析  

Meninges metastases of lung cancer:report on 15 patients

作　　者：陈东福[1] 李建英[1] 殷蔚伯[1] 王绿化[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院放射治疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2000年第1期36-38,共3页Chinese Journal of Radiation Oncology

摘　　要：目的　回顾性分析肺癌脑膜、脊膜转移的临床表现、治疗经过及预后。方法　 15例肺癌脑膜、脊膜转移病例中 ,肺原发病变组织学诊断 11例 ,临床诊断 4例。 14例有脑部症状 ,其中 5例伴有神经根的症状 ,1例只有神经根的症状。脑膜伴脑转移 6例 ,脊膜伴脑转移 4例 ,脑膜转移 3例 ,脑膜、脊膜伴脑转移 1例 ,脊膜转移 1例。 14/ 15有脑或 (和 )脑膜转移。 14例中行全脑照射 10例 ,DT30～ 40Gy ,15次 ,2例未行全脑照射 ,2例未完成照射。脊髓照射 4例 ,DT2 1～ 40Gy ,7～ 15次。 结果　全脑照射后神经系统表现及体征改善 7例 ,脊髓照射后 3例症状改善。脑MRI示病变消失和缩小分别为 2例和 4例 ,脊髓MRI示病变消失 1例 ,缩小 3例。照射者中位生存期 6个月 ,未照射者为2个月。 12例死于脑和 (或 )脑膜、脊膜广泛转移 ,3例由于全身病变广泛伴全身衰竭而死亡。结论　肺癌脑膜、脊膜转移行姑息性脑和 (或 )脊髓放射治疗 ,对减轻患者痛苦 ,改善生存质量 ,延长生存期有重要的意义。Objective To retrospectively analyze the clinical manifestations, treatment and prognosis of 15 patients with meninges metastases of lung cancer.Methods From January. 1994 to April 1999, 15 lung cancer patients with metastases to the meninges were treated. Male 9 female 6. Pathologic confirmation was obtained in 11 and the rest 4 were diagnosed clinically. Fourteen patients had symptoms referable to the brain. Six had nerve root symptoms. One had spinal meningeal metastases. Whole brain irradiation was given to 10 at doses of 30～40?Gy in 15 fractions. Spinal cord irradiation was given to 4 at doses of 21～40?Gy in 7～15 fractions. Results mprovement in nervous and general symptoms and signs was observed in 7/10 patients. After spinal cord irradiation, symptomatic improvement was noted in 3/4. Complete and partial resolution were observed by MRI in 2 and 4, respectively. Complete resolution of the spinal lesion as shown by MRI was observed in 1and partial resolution in 3. The median survival of the irradiated patients was 6 months and that of the un irradiated ones, 2 months. Cause of death : 12 died of brain and meninges extensive metastases and 3 died of general cachexia. Conclusion Irradiation to the brain and /or spinal cord is able to relief symptoms and prolong survival in lung cancer patients with meninges metastases.

关 键 词：肺肿瘤 肿瘤转移 脑膜转移 脊膜转移 

分 类 号：R734.2[医药卫生—肿瘤] R73－37[医药卫生—临床医学]